离子导入辅助角膜交联治疗青少年圆锥角膜（英文）

Iontophoresis-assisted corneal cross-linking in pediatric keratoconus

目的:评估离子导入辅助的跨上皮角膜交联治疗青少年圆锥角膜的安全性和有效性。方法:搜集12例(年龄12!18岁,平均15.8±2.08岁)进展期圆锥角膜患者,共15眼,采用0.1%核黄素蒸馏水溶液,离子导入(1 m A电流)辅助跨上皮给药5min,紫外线A(370 nm,3 m W/cm^2)照射30min。记录术前、术后3mo和1a的裸眼视力、最佳矫正视力、K_1、K_2、最大K值、平均K值、角膜散光度数、角膜内皮细胞密度、眼内压、最薄角膜厚度、角膜顶点厚度。角膜参数应用角膜地形图评估,角膜内皮细胞密度应用非接触角膜内皮镜检查。结果:角膜交联1a后,裸眼视力、最佳矫正视力、K_1、K_2、最大K值、平均K值、角膜散光度数、角膜内皮细胞密度和眼内压均无显著变化。最薄角膜厚度从468.08±33.40μm下降到447.46±40.20μm(t=4.379,P=0.001),差异有统计学意义。角膜顶点厚度从476.07±35.96μm下降到454.60±49.32μm(t=4.270,P=0.001),差异有统计学意义。结论:采用0.1%核黄素蒸馏水溶液的离子导入辅助的角膜交联治疗青少年圆锥角膜是安全、有效的,1a内能够阻止病情恶化,但是长期效果有待于进一步观察。

AIM：To evaluate the efficacy and safety of iontophoresis- assisted transepithelial corneal cross-linking（ I-CXL） in a population of patients younger than18 y.METHODS： Fifteen eyes of 12 patients aged 18 y or younger（ mean age,15. 8 ± 2. 08y; range,12- 18y） were treated. After 0. 1% riboflavin-distilled water solution was administered by iontophoresis- assisted（ Current 1mA）transepithelial method for 5min in total,standard surface UVA irradiation（ 370 nm,3 mW / cm2） was performed for30 min. The uncorrected visual acuity（ UCVA）, best corrected visual acuity（ BCVA）, K_1, K_2, K_（max）, K_（mean）,corneal refractive astigmatism,endothelial cell density,intraocular pressure（ IOP）,the corneal apex thickness and the thinnest corneal thickness were measured preoperatively 3mo and 12 mo postoperatively. Corneal parameters were assessed by corneal topography（ Wavelight, Allergro Topolyzer Topolyzer Vario,Germany）. Corneal endotheliumwas photographed with a noncontact Specular M icroscope（ SP 2000, Topcon,Japan）. RESULTS： Twelve months after the procedure, no significant changes occurred in the UCVA,BCVA,K_1,K_2,K_（max）,K_（mean）,corneal refractive astigmatism,endothelial cell density and IOP. The thinnest corneal thickness decreased from468. 08±33. 40 μ mto 447. 46±40. 20 μ m（ t =4. 379,P = 0. 001）. The corneal apex thickness decreased from476. 07±35. 96 μ mto 454. 60±49. 32 μ m（ t = 4. 270,P =0. 001）. The differences of the above were both statistically significant.CONCLUSION： I- CXL using 0. 1% riboflavin- distilled water solution for pediatric keratoconus is effective and safe which can halt deterioration of keratoconus within1 y,but permanent effects still need to be observed.